How can you tell if the meniscus is involved with your knee pain?! A quick internet search on "why does my knee click" has officially booked your appointment with Dr. Google, where you were promptly "diagnosed" with a torn meniscus!?
And the only way to fix a meniscus tear is with a surgery, right?!
Not quite!
The meniscus...a structure that has become increasingly trendy to just have a quick surgery to "clean it up." But before you agree to a surgery, shouldn't you know what the heck is a meniscus and what are your other options?
What is the Meniscus?
You have two menisci per knee joint, one on the lateral (outer) side of the knee and one on the medial (inner) side.
~Side note, I personally think menisci is a fun word and I suggest using it in conversation to impress your friends~
To keep it short & simple, the menisci are attached to the top of the tibia (shin bone) and primarily serve as a shock absorber in your knee joint to help cushion and protect the joint during weight-bearing activities - like stairs, squatting, and walking. The lateral meniscus is more 'O' shaped while the medial meniscus is more 'C' shaped. They are made of cartilage; however, this cartilage is not the same as the articular cartilage associated with arthritis. They have other responsibilities such as: deepening the joint, providing lubrication to the joint, adding extra stability to the knee, and assisting with knee motion.
The knee joint itself is a complex joint, consisting of a litany of ligaments, tendons, bones, muscles, fascia, nerves, arteries, etc. which all work in harmony to allow functional movements to support your body weight in a variety of body positions - so how can you be so sure that the meniscus is involved or the root cause of your pain?
And to further muddy the waters, did you know that one of your hamstrings has an indirect attachment to the medial meniscus! Does this explain why certain exercises you tried can make the pain worse? (that's right, your hamstring is more than just one muscle - but maybe we'll save that topic for later.)
How do you know if your Meniscus is involved?
If your symptoms include:
A history of knee catching or locking
Pain with forced hyperextension (extreme knee straightening)
Pain with forced hyperflexion (extreme knee bending)
Joint line pain & tenderness to "poking"
(And for the meniscus police out there, the 5th component of the meniscal pathology score is a positive McMurray's test, but it is indeed difficult to perform that on yourself.)
If you have all 4 positives above, then there is a 90% chance you have meniscus dysfunction (and technically 99% if all 5 are positive).
The final icing on the cake is the inability to balance on the leg with the suspected tear, while maintaining a slightly bent knee, keeping the foot planted, and rotating your body to look at the wall behind you. If you can do that without reproducing the same exact pain, then maybe we need to look beyond the meniscus and at one of the many other structures in the knee.
So you have all the signs, what's next? Surgery?! NOPE!!
Meniscus issues are extremely common in the active adult population and should be treated without surgery. In fact, surgery is largely unnecessary for the majority of meniscus injuries and should be treated first with conservative care. It has been proven in studies that many knee scopes (an Arthroscopic Meniscectomy) with the sole intention to "clean out" or "clean up" the meniscus show little to no benefit in long term follow ups compared to patients who opted to not have the surgery.
This is exactly the type of patient we see regularly at Flow Physical Therapy and Wellness in The Woodlands, TX. Patients who are either trying to avoid surgery with conservative care, or still struggling with the same symptoms they had before they were convinced to have a surgery years prior.
So if you think you may be struggling with a new or old meniscus injury and you are ready for real answers AND a plan, a plan that includes the research-proven interventions and techniques, click the button below to get started and learn more!
Dr. Patrick Thompson, PT, DPT, OCS, Cert. DN
Owner of Flow Physical Therapy and Wellness
832.299.5447